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How to check for Coronary artery disease?

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THE DAY MY PROBLEMS STARTED (SUMMER 2001) At the age of 21 (summer 2001), as I was ending my seventh or eight consecutive streetball game (three on three) for the day and preparing to cool down, I suddenly felt an unbearable tachycardia, irregular palpitations that resembled a horse run, followed by an instant cold/warm sweat on my forehead, nausea that spread upwards from my lower abdomen, intense trembling in both my arms and finger tips, a feeling that my legs had been cut from knees to heals, and what was most scary, a severe dyspnea that lasted for days and weeks afterwards at a different level of intensity and made me go to the ER once. Prior to that infamous day, during a ten-year period of semi-professional basketball career, I had had no symptoms at all, except a few of times separated by multiannual intervals (at the age of 12, and then 17-18) when I had experienced some warning signs such as a sudden dyspnea on/after exertion (weigh-lifting) or while in a steam room/hot tab/hot weather, and a sharp, thunder-like chest pain at rest lasting for a second or less. Nonetheless, that hot summer day was "special" - 41 degrees Celsius in a shadow, around 18:00 hours, with me having had an extreme lack of sleep for almost the entire summer because of my intense social life and night-time partying (no active smoking, no drugs, just less than moderate amounts of alcohol, mostly beer). I immediately left the playground and rushed to a private specialist for internal medicine since he was at that time the only one in possession of a 3D Doppler Echo in our small town in eastern Macedonia . That same day I was diagnosed for the first time in my life with MVP, namely a "discreet" [I assume this means mild] prolapse of the left mitral cusp" and a "particularly mobile/dynamic function of the valve apparatus." Although this seemed to be the right diagnosis of my problem, perhaps congenital and never looked into seriously, the doctor bluntly dismissed the seriousness of this "heart condition" (rather than decease) affecting, according to his words, "from 5 to 20%" of the general population." He also told me to calm down, relax a bit, "since many athletes have the same with no serious implications," and gave me some beta blockers that only made my "anxiety" condition worse in the next couple of months. OTHER RELATED CONDITIONS As I would later learn, this downplaying attitude towards MVP is upheld by most of the physicians in the world, particularly those who have been closely involved in my case. In the early days, some cardiologists even recommended that I continue with my strenuous exercise tempo and visit a good psychologist or psychiatrist. Of course, twelve years have past since then and whatever I have done I have only struggled to overcome my nasty symptoms that seem to have become more frequent lately, albeit not more intense. Over the past decade, I was also diagnosed (ECG, 2002-3) with "a right bundle branch block" (recommended diazepam and asked if I do steroids though I deliberately avoid even antibiotics when I am sick), as well as with a sliding hiatus hernia and GERD (endoscopy, 2008-9; this is something that I know I have had since teenage years). I have deliberately avoided taking any drugs (diazepam, amoxicillin) and I still do that in line with my principles. In the last two years, (I have been residing in Canada since 2009), however, I have had to call 911 twice as a result of intense MVP/heart attack symptoms that began occurring at rest. NO STRICT PATTERN OF SYMPTOMS AT REST I cannot identify a strict pattern of symptoms at rest, although I am certain they are triggered and made more intense by a considerable lack of sleep (sometimes I sleep only 4 hours a day and, since recently, I have also done some night shifts), excessive sugar and fat consumption (e.g. chocolates which I am addicted to), excessive single meals, even a mild dose of alcohol etc. Both times I was recently taken to the emergency room I underwent a longer-than-usual ECG tests but the latter showed nothing but sinus tachycardia (about 120 bpm) and "anxiety." Last weak, the night after I did a couple of strenuous night shifts for the first time in my life, I had guests in my house. As I was preparing food for them, I suddenly felt a sharp, radiating chest pain for a seconds or two, followed by a sense of fear and panic, the well-known sweating on the forehead, trembling, terrible weakness, slower speech, and breathlessness. I was on the edge of calling 911 once again but instead I did what I usually do in this situation: I immediately went out of the house to feel the cold and take a fresh breath for a minute, and I then drank a big glass of natural, home-made lemon juice with honey. This condition is usually preceded and accompanied by a more intense discomfort In the upper back, above and around my left shoulder blade. On the other hand, I cannot strictly relate this discomfort to a cardiac condition, since it has also been muscle-related, occurring ever since my basketball days, especially after exertion, strenuous heavy lifting exercises, prolonged sitting, uneasy sleep, or sleepless nights. REGULAR PATTERN OF SYMPTOMS ON EXERTION Luckily, I am able to describe a regular patter of symptoms, often involving a near syncope, in the immediate cool down phase of almost every demanding physical exercise that I do (basketball, swimming, heavy lifting). And this pattern has been constant since the very beginning in 2001. It goes as follows: it starts with a sudden sensation of nausea radiating from my lower abdomen upwards and has never involved any kind of chest pain on exertion (sharp, burning, heaviness), It is then followed by instant (feeling of) sweating on my forehead, trembling, tachycardia, often including palpitations/extra-systoles, and all that resulting in a progressive dyspnea and a feeling of airflow blockade somewhere around the plexus and diaphragm (I literally gasp for air), fullness in my entiire thorax and throat, consequent lightheadedness, sometimes blurred (once grey) vision and a near-fainting. This condition is triggered by either one basketball game one on one or three on three, or more intense jogging for about a mile (3 laps around a soccer field), or swimming about 10 laps in a 25m-long pool, or moderate weight-lifting for 15 minutes. It is always triggered by more "strenuous" exertion, the latter being nothing, zero effort compared to the three-times-per-day practice during my basketball career. And the awful feeling lasts until I sit, calm down, lay down horizontally, and decrease a bit my heart rate which nonetheless remains at a higher-than-normal level hours after practice. As for the "activation" of the pattern itself, as if there is a "red line" and when I cross it the symptoms as described start making me feel doomed, as if I am done with this life. Weirdly, the red line is sometimes higher, sometimes lower, very much depending on my mood and previous rest. Sometimes I get these consecutive symptoms after only a 200m run or just 4 laps in the pool, yet sometimes I have to "overexert" myself, say, with one-mile jogging or 10 laps in the pool before the symptoms start menacing my positive spirit. I have to mention here several very important facts about my body reaction on exertion: 1) On exertion, the pattern/MVP symptoms never start(s) - or at least I don't feel them except sometimes palpitations - in the beginning, nor while I actually run, swim, and lift continuously, in full force. I begin feeling them only in the cool-down phase of an individual exercise which has crossed the "red line," that is when I slow down after crossing the "red line." Interestingly, if I "survive" this phase without augmented fears and continue exercising, my heart behaves as of it has got used to the new, higher tempo, my air pipes open up widely, and I (feel I) can continue the practice like in the good old days, without any problems. But this fake capacity usually lasts a little while, that is until I reach another heart-rate culmination which feels more XXXXXXX Regardless, I mostly feel the symptoms immediately after I stop the practice abruptly and entirely, and It often happens that these symptoms surge up when I am actually taking a shower 5 minutes after practice. Half an hour after practice I recover and feel perfect and this usually lasts until the next morning. The day after the practice, once I get up from bed, I often get the same scary symptoms though less intense, and it feels that my heart and body are once again starting from zero, unprepared for orthostatic and exertional pressure. 2) second, the said pattern of symptoms gets much easily "activated," meaning the "red line" is lower and the symptoms worse, when I lift weights or combine body building and running. This sensitivity and exertional resistance to anaerobic, isometric activities seems to be the best indicator of the existence of a cardiac condition, especially an MVP syndrome. 3) third, the induction/onset of "heart attack" symptoms and near-syncope, although scary and prolonged, particularly during hot and humid summer days, is slowly reversed as soon as I lay down and thus mitigate the apparent obstruction to blood circulation to the brain. By the same token, my exertion tolerance increases and I can do more and longer if I opt for stomach-related or other exercises in supine position such as swimming (but no push-ups). This is another indicator of the existence of a blood circulation obstruction somewhere in my body (does not have to be MVP-related). 2013: THE ORIGINAL MVP DIAGNOSIS RULLED OUT BUT SYMPTOMS REMAIN, POSSIBLY CAD? The major problem now is that after all these complementary diagnoses and continuing problems affecting the quality of my life and sports activities, my Canadian/Manitoban doctors have found nothing wrong with my heart. They say they cannot see any MVP, nor even mild, reiterating that I have no structural issues with my heart. They not only deny the original Macedonian MVP diagnosis but also cleared me in full, informally suggesting that, so far as they are concerned, I can get involved in professional sports. In 2013 I went through all the normal, non-invasive testing procedures known to mankind, namely ECG, stress test, 24h holter monitor, and echo cardio (which should logically be a more sophisticated equipment than the one that originally discovered MVP in 2001). These tests detected only sinus tachycardia (my family MD in Manitoba initially suspected atrial fibrillation), "anxiety disorder," and POTS (postural orthostatic tachycardia syndrome). Please advise. Despite the fact that these problems have began occurring at rest and continue to prevent me from weight-lifting and playing the game of basketball which I love, my MD is currently unwilling to continue with any tests suggesting that I take some pills to calm down. My doubts also persist since my mom had a heart attack at the age of 42 (she is a heavy smoker diagnosed with CAD but was not inserted stents because the channels/arteries were purportedly too narrow and she has benunwilling to go for a pace-maker). I constantly think that if my MVP was truly misdiagnosed in 2001 (as purportedly shown by the recent tests) there must be another underlying condition which the recent tests did not show. Could it be CAD?
Posted Tue, 25 Feb 2014 in General Health
Answered by Dr. Sumer Choudhary 13 hours later
Brief Answer: not to worry Detailed Answer: Your MVP diagnosis shouldn't worry you as this is not a very serious disease. However going through your description it seems to be definitely an anxiety problem. You can undergo repeat holter monitoring for a longer period of duration,as well as cardiac CT and angiography for ruling out CAD. You being a sports person, your cardiac physiology would be slightly different from normal individuals, which is nothing to worry about.
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